This study examined the inefficiencies of transferring radiology images between hospitals during pediatric trauma transfers. It found that imaging was unable to be uploaded to the receiving hospital's records 27.8% of the time, necessitating repeat CT scans 1.2% of the time. Using cloud-based systems could allow receiving hospitals instant access to outside imaging, eliminating unnecessary repeat scans, treatment delays, and reducing costs. Radiation exposure from CT scans increases cancer risks for children and cloud-based sharing could help minimize further exposure.

1. Pediatric Trauma Radiation Exposure Dilemma- Opportunities for
Improvement with iCloud Radiology
Yana Puckett, MD, MPH Student; Jose Greenspon, MD, FACS
Introduction
This study examined the inefficiencies
of radiologic imaging transfers from one
hospital to another during pediatric
trauma transfers in an era of cloud
based information sharing.
Effects of Hospital Radiation Exposure
in Children
• Radiation exposure during CT of major concern in
children.
• Over 7 million scans performed in children over last
decade, mostly for trauma and appendicitis.
• Longitudinal, population-based study in Great Britain
demonstrated an increased incidence of leukemia and
brain cancer after repeated CT scans in children (*).
• Models extrapolated from radiation exposure from atomic
bomb explosions- one fatal cancer per 1000 CT scans
performed in young children estimated (*).
• Children have a longer life expectancy than adults,
resulting in a larger window of opportunity for expressing
radiation damage.
• Children may receive a higher radiation dose than
necessary if CT settings are not adjusted for their smaller
body size.
Methods
• A retrospective review of all patients
transferred to a pediatric trauma center
in in Saint Louis between 2008 and
2014 was performed. Data was divided
by the type of trauma sustained, time
spent at outside hospital before
transfer.
• Imaging was reviewed to see if outside
hospital obtained imaging, whether
accompanied the patient, whether
imaging was able to be uploaded onto
computer for records, whether imaging
had to be repeated, whether labs had
to be repeated, whether imaging
obtained at the outside hospital was
done unnecessarily.
Results
• We reviewed 521 charts.
• Imaging was sent with the patient 87.7%
of the time.
• Imaging was unable to be uploaded to
EMR 27.8% of the time.
• CT imaging had to be repeated 1.2 % of
the time.
• CT scan was done unnecessarily or not per
universal pediatric trauma guidelines 1.2%
of the time.
Conclusion
• Pediatric trauma transfer patients often
come to an accepting facility with films that
require duplication or are not able to be
uploaded to the electronic health records at
receiving hospitals.
• This results in significant transfer
delays, missing diagnostic information,
loss of imaging, unnecessary irradiation
to child, and increased cost to
healthcare system.
• Cloud based radiology systems are
widely available to be incorporated into
hospital systems and can allow instant view
of labs and imaging from another hospital
eliminating unnecessary repeat imaging,
delays in treatment, and decreasing
healthcare costs dramatically.
* Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of
leukaemia and brain tumours: A retrospective cohort study. Lancet 2012;380: 499–505.